We received 209 completed surveys for a response rate of 42%. The population of survey respondents differed significantly from the overall clinic population in the demographic categories of race (p<0.001) and age (p<0.001), but not gender (p=0.08); the population of survey respondents contained a greater percentage of white and middle-aged patients than the overall clinic population. More respondents self-identified as white than as any other category (). More reported an annual household income of greater than $75,000 than any other category, although the remaining respondents were relatively evenly distributed throughout the other income categories. Just over half were college-educated. The majority of survey respondents reported good or excellent health.
Demographic information on survey respondents
The survey data suggest that respondents were relatively sophisticated regarding computer use. Eighty-six percent (95% CI, 81% - 91%) used computers. Ninety-six percent (95% CI, 93% - 99%) had access to the Internet, and 86% (95% CI, 81% - 91%) had been using the Internet for 2 years or more.
The 15% (95% CI, 10% - 20%) of respondents who reported that their health was "fair" or "poor" reported less computer use and access than the overall surveyed population. Thirty-eight percent (95% CI, 21% - 55%) of those in fair or poor health reported not using a computer at all. Only 63% (95% CI, 46% - 80%) of those in fair or poor health had Internet access, and only 28% (95% CI, 12% - 44%) had used the Internet for two years or more.
Respondents trusted health information from their physicians more than health information from other sources. Health websites were the next most trusted source, and were slightly more trusted than public radioand newspapers, and much more trusted than online newspaper sites, other online news sources, TV shows and news reports, magazines, other people, and other radio sources ().
Percentage of survey respondents reporting they trust various forms of communication either "a lot" or "completely"
During late 2001, respondents received very little information on anthrax and/or bioterrorism from physicians, reportedly the most trusted source of information. Only 4% (95% CI, 1% - 7%) of respondents reported that their physician gave them information about anthrax in person. However, extrapolating from the proportion of patients expected to have had office visits during this time, it is possible that up to 12% of patients seeing their physicians received information about anthrax. Just 1% (95% CI, 0% - 2%) said that their physician sent them information on anthrax through the postal mail. Only one respondent (< 1%) reported receiving an e-mail from their physician with information on anthrax.
Only 12% (95% CI, 7% - 17%) reported that they obtained "a lot" of information from health websites, the next most-trusted source after physicians. Despite television shows and news reports being reported as the least trusted source of information, more people (51% (95% CI, 44% - 58%) reported receiving "a lot" of information about anthrax and bioterrorism from this source than from any other source.
Sixteen percent of respondents (95% CI, 10% - 22%) said that as a result of September 11th and the anthrax scare, their overall use of the Internet increased between September and December of 2001. Twenty-one percent (95% CI, 15% - 27%) of respondents reported searching the Internet for information on bioterrorism and/or anthrax during late 2001. This group reflected a population that tended to be more educated and wealthier than the overall surveyed population, with a greater proportion of White (). Of those who searched the Internet for information on bioterrorism and/or anthrax, 54% (95% CI, 41% - 67%) reported that they did so because they wanted more information than they were getting from other sources. In addition, 63% (95% CI, 54% - 72%) of searchers turned to the Internet for information on the risk of catching anthrax and/or on how to protect oneself from anthrax exposure. Eighty-eight percent (95% CI, 79% - 97%) of searchers reported that they did not get any advice on where to search for information on anthrax and/or bioterrorism. Sixty-five percent (95% CI, 53% - 77%) located their information by searching for the word "anthrax" or "bioterrorism". Forty percent (95% CI, 27% - 53%) obtained their Internet information from online newspapers, 25% (95% CI, 14% - 36%) from private health websites like WebMD or Medscape, and 26% (95% CI, 14% - 38%) from public health websites like www.cdc.gov (Centers for Disease Control).
Demographic information on survey respondents who searched the Internet for information on anthrax and bioterrorism and survey respondents who did not search the Internet for such information
Those who searched the Internet tended to be white, female, and well-educated, although statistical analyses did not reveal any statistically significant differences in the demographic profiles of those who searched the Internet and those who did not. Note that seven survey respondents did not provide information regarding whether they searched the Internet for information on anthrax and bioterrorism, and these seven respondents are excluded from this table.
Internet information had an effect on the behavior of those who searched for such information. Of the respondents who reported searching online for information relating to anthrax and/or bioterrorism, 58% (95% CI, 44% - 72%) reported that they handled mail differently as a result, and 65% (95% CI, 52%-78%) reported that they washed their hands more often as a result of such information.